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By C. Kor-Shach. Centenary College of Louisiana.

Quetiapine Quetiapine is an effective antipsychotic which has a receptor binding profile similar to clozapine order sinequan 10mg overnight delivery, but with relatively lower affinity for all receptors 75 mg sinequan overnight delivery. The side-effect profile is favourable generic 75 mg sinequan with visa, 75% of respondents denying any side-effects (Hellewell et al purchase sinequan 25mg online, 1999) buy sinequan 25mg visa. Sedation and hypotension are reported, especially during the commencement phase. Weight gain, and the risk of diabetes and hyperlipidemia need to be considered. Quetiapine has little affinity for muscarinic receptors so that blurred vision and difficulty with micturition are rarely problems. The rate of EPS symptoms is similar to placebo and there is no significant elevation of prolactin. Amisulpride Amisulpride is a useful antipsychotic which has effects (potent antagonist) only at D2 and D3 receptors, and no effect on serotonin receptors. Thus, it could be considered an FGA, which was released in the age of the SGAs. At recommended doses it appears to be selective for limbic (rather than extra-pyramidal system) receptors (Xiberas et al, 2001). Unfortunately, when higher doses are required, EPS side-effects may become a problem. Amisulpride is less likely to cause weight gain than the other SGAs, but it produces robust elevation of prolactin levels, thus breast development and lactation in both men and women and amenorrhoea in women may be bothersome side effects (Leucht et al, 2013). Some guidelines list amisulpride as benign with respect to QTc prolongation and sudden death (Hasan et al, 2012). It has low sedation effects, and discontinuation rate, suggesting it is well tolerated. Aripiprazole Aripiprazole is unusual - rather than an antagonist of dopamine receptors, it appears to be a high affinity partial agonist at presynaptic D2 receptors and an antagonist at postsynaptic D2 receptors. It has little affinity for D3, D4 and D1-like receptors, and its affinity for 5HT-2A receptors is low. There is some alph-1 blockade and orthostatic hypotension has been reported. The efficacy appears similar to risperidone and less than olanzapine, but the side-effect profile appears favourable at manufacturer recommended doses, with minimal elevation of prolactin (Komossa et al, 2009). However, a recent review demonstrated no clear advantage over many other SGAs (Khanna et al, 2013). Aripiprazole has a role as a mood stabilizer (Keck et al, 2007). It appears to be an effective antipsychotic (compared to the other available agents – but, none of them are much good). It has a lower profile of weight gain and adverse changes in glycemic or lipid profile (Bobo, 2013), which will be considered an advantage. It does not significantly increase prolactine (Leucht et al, 2013). However, dose related akathisia and oral hypoaesthesia, my be problematic. Blonanserin, Iloperidone, Lurasidone, and Sertindole Blonanserin has been released for use in Japan and Korea. It appears to be an effective anti-psychotic, which lowers the serum prolactin level (Kawabe et al, 2013. Iloperidone and Lurasidone have been released in the USA but their place in the clinical armamentarium remains to be determined. The question has been raised (Leucht et al, 2013) – with the earlier SGAs coming off patent – will these newer SGAs be cost-effective (good value for money). ACUTE AND LONGTERM ANTIPSYCHOTIC USE Acute treatment is straightforward if the patient is able to cooperate and accepts oral medication. One of the SGAs should be commenced immediately and raised to the generally agreed therapeutic level over a few days. Dosage needs to be tailored to the particular patient. Initially, a regular small amount of a benzodiazepine may help with distress and insomnia. No action should be taken until sufficient personnel are available – the last thing we want is a fight.

Ethanol oral self-administration is increased in ethanol intoxication discount sinequan 75 mg mastercard. Am J Psychiatry 1994;151(10): mutant mice with decreased beta-endorphin expression order sinequan 75mg with visa. Naloxone retards the expression of a subjective side effects: a preliminary study effective sinequan 75mg. Alcohol Clin Exp Res genetic predisposition toward alcohol drinking discount 75 mg sinequan fast delivery. Importance of delta opioid receptors in tor responses to alcohol in heavy drinking subjects generic sinequan 75 mg. Consumption of ethanol solution is poten­ tration in heavy drinkers. Alcohol Clin Exp Res 1999;23(2): tiated by morphine and attenuated by naloxone persistently 195–203. Decrease in ethanol duced nausea in patients treated for alcohol dependence: clinical consumption by naloxone in naive and dependent rats. Pharma­ predictors and evidence for opioid-mediated effects. J Clin Psy­ col Biochem Behav 1983;18(suppl 1):537–539. Acamprosate modulates synaptosomal GABA aversion and alcohol drinking behavior. J Pharmacol Exp Ther transmission in chronically alcoholised rats. Acamprosate enhances N-methyl-D-apartate naltrexone in the treatment of alcoholism. Results from a multi- receptor-mediated neurotransmission but inhibits presynaptic center usage study. Arch GABA(B) receptors in nucleus accumbens neurons. Naltrexone and alcohol dependence: role microdialysate in ethanol withdrawn rats. A double-blind, placebo-controlled pilot study cology and clinical potential in the management of alcohol de­ to evaluate the efficacy and safety of oral nalmefene HCl for pendence after detoxification. Acamprosate appears to decrease alcohol in- 1162–1167. Calcium acetyl homotaurinate for maintaining patients with alcohol dependence. Am J Geriatr Psychiatry 1997; abstinence in weaned alcoholic patients; a placebo controlled 5(4):324–332. Naltrexone and cognitive behavioral therapy Novel pharmacological interventions for alcoholism. New York: for the treatment of outpatient alcoholics: results of a placebo- Springer-Verlag, 1992:348–352. Six-month follow-up of naltrexone and psy­ term withdrawal of alcoholic patients]. Ther Umsch 1993;50(3): chotherapy for alcohol dependence. Naltrexone treatment of acamprosate in maintaining abstinence from alcohol. Nefazodone for treatment a placebo-controlled study on alcohol dependence [published of alcohol dependence. Neuropsycho­ erratum appears in Arch Gen Psychiatry 1996;53(12):1097]. Comparison of acamprosate and placebo 1458 Neuropsychopharmacology: The Fifth Generation of Progress in long-term treatment of alcohol dependence [see comments]. Placebo-controlled trial of fluoxetine as an the appetite for alcohol in weaned alcoholics? J Pharm Belg adjunct to relapse prevention in alcoholics.

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